Evaluation of factors affecting treatment and mortality in patients over 65 years of age and without chronic disease, followed in the Intensive Care Unit due to COVID-19.

OBJECTIVE: In this study, demographic, clinical, and laboratory data of patients aged 65 and over who are followed on mechanical ventilators due to COVID-19 in intensive care clinics will be useful in terms of strategies to be developed in the fight against COVID-19 and other infectious agents. PATIENTS AND METHODS: Our study included 299 patients aged 65 years and older, who were not chronically ill, and who were followed up on mechanical ventilators due to COVID-19 in intensive care clinics in the period between 2020 and 2022. Our study was designed as a retrospective cross-sectional study. The demographic characteristics of the patients included in the study, their complaints during hospitalization, the time between the beginning of the complaint and the admission to the hospital, the vital signs at the time of admission to the hospital, the lung computed tomography findings during hospitalization, and the treatments given were examined. RESULTS: 55.9% of all patients were males, and the mean age was 75.45±7.47 years. While there was no significant difference in terms of mean age between the groups of patients with/without a higher risk of mortality, there was a significant difference in gender (p=0.025). There was a statistically significant difference between the COVID-19 intensive care (p=0.001) and renal failure (p=0.014) and mortality groups. The mean nutric score, Procalcitonin (PCT), Lactate Dehydrogenase (LDH), Blood Urea Nitrogen (BUN), Phosphorus, and lactate values, which are important parameters, were statistically higher in the group with a higher risk of mortality (p<0.001). In addition, there was a statistically significant difference in terms of sepsis, neuromuscular blocker (Nmb), vasopressor, and intubation between the groups of patients with/without a higher risk of mortality (p<0.001). In the group with high mortality, 34.2% (n=55) had plasmapheresis treatment, and 14.2% had hemodiafiltration treatment (p<0.001). According to the results of the multivariate logistic regression model in determining the factors associated with a higher risk of mortality, those who were males (p=0.001), those with kidney failure (p<0.001), those with organ failure (p=0.006), increased in alanine aminotransferase (ALT) values (p=0.019), those with sedation (p=0.001) and those with vasopressors (p<0.001) were found to have an increased risk of mortality. CONCLUSIONS: We think that our study is valuable in terms of determining the most appropriate treatment strategies by following the patients in terms of parameters that are significant in the findings during their follow-up period in the Intensive Care Unit.

Real world results of venetoclax combined with hypomethylating agents in relapsed/refractory AML.

OBJECTIVE: Relapsed/refractory AML cases are much more resistant to chemotherapy. Venetoclax is a highly sensitive BCL-2 inhibitor. It was aimed to evaluate the effects of venetoclax therapy on real-world R/R AML survival outcomes, the effects of the cytogenetic characteristics of the patients and previous clinical applications on treatment response, and venetoclax treatment toxicity. PATIENTS AND METHODS: The study included patients who only received a venetoclax-based salvage on R/R AML patients from Turkey. The study included a total of 62 patients from 6 different centers in Turkey. Response to 2 cycles of venetoclax treatment was assessed by bone marrow blast rate. The demographic data, cytogenetic characteristics, AML type, MDS type, response rates and overall survival of the patients after venetoclax combination treatment were assessed. Median age of the patients was 65 (19-85). Mean number of prior treatments was 2.67 ±1.75. RESULTS: 13 patients (21%) had a history of allogenic stem cell transplantation. 58 (93.5%) had received HMA therapy before venetoclax. 36 patients (58.1%) had de-novo AML, and 25 (40.3%) previously had MDS. Treatment response was evaluated as complete remission (n = 21, 33.9%), partial response (n = 17, 27.4%), and treatment failure (n = 24, 38.7%). Patients in the TF group were significantly more likely to have poor cytogenetic and to have received allogeneic transplants. The mean estimated overall survival after the venetoclax treatment was 9.13 ± 0.75 months. CONCLUSIONS: The study population consisted of a group of patients who had relapsed or primary refractory disease with poor prognosis, despite numerous rounds of chemotherapy. It is our belief that the high response rates obtained with the combination of venetoclax/HMA, and having obtained positive results with poor risk patients, indicated a promising perspective for R/R AML patients.